Population-Based Colonoscopy Screening for Colorectal Cancer: A Randomized Clinical Trial.
Population-Based Colonoscopy Screening for Colorectal Cancer: A Randomized Clinical Trial.
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DOI：
10.1001/jamainternmed.2016.0960
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发表时间：
2016-07-01
影响因子：
39
通讯作者：
Nordic-European Initiative on Colorectal Cancer (NordICC) Study Group
中科院分区：
文献类型：
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作者：
Bretthauer M;Kaminski MF;Løberg M;Zauber AG;Regula J;Kuipers EJ;Hernán MA;McFadden E;Sunde A;Kalager M;Dekker E;Lansdorp-Vogelaar I;Garborg K;Rupinski M;Spaander MC;Bugajski M;Høie O;Stefansson T;Hoff G;Adami HO;Nordic-European Initiative on Colorectal Cancer (NordICC) Study Group
虽然一些国家已经实施了广泛的结肠镜检查，但大多数欧洲国家尚未引入结肠镜检查，因为在参与率、手术相关的疼痛和不适、内窥镜医生的表现和有效性方面存在不确定性。目前还没有结肠镜筛查的随机试验。调查以人群为基础的结肠镜筛查的参与率、成功率、表现和不良事件。波兰、挪威、荷兰和瑞典的随机对照试验平均风险人群，以人群为基础。94,958名55至64岁的男女。结肠镜检查或不检查。本文报道了筛选参与、产量和受试者经验。研究结果按国家和内镜医师进行比较。在31420名随机接受结肠镜检查的合格受试者中，12574名（40%）参加了筛查。挪威的参与率为60.7%，瑞典为39.8%，波兰为33%，荷兰为22.9% （p<0.001）。盲肠插管率为97.2%，其中9726例（77.3%）患者未接受镇静。我们观察到1例穿孔（0.01%），2例息肉切除术后浆膜烧伤和18例息肉切除术后出血（0.15%）。结直肠癌62例（0.5%），腺瘤3861例（30.7%），其中高危腺瘤1304例（10.4%）。近端和远端结肠的检出率相似。内镜医师之间的表现差异显著；分别有6名（17.1%）和10名（28.6%）内窥镜医师未达到盲肠插管（95%）和腺瘤检测（25%）的推荐基准。标准充气组有16.6%的患者报告结肠镜检查后出现中度或重度腹痛，而二氧化碳充气组有4.0% （p<0.001）。结肠镜检查在近端和远端结肠的检出率很高。参与率和内窥镜医师的表现筛查差异很大。术后腹痛是常见的标准空气充气，可以通过使用二氧化碳显著减少。NCT 00883792。
While some countries have implemented widespread colonoscopy screening, most European countries have not introduced it because of uncertainty with regard to participation rates, procedure-related pain and discomfort, endoscopist performance, and effectiveness. No randomized trials on colonoscopy screening exist today. To investigate participation rate, yield, performance and adverse events of population-based colonoscopy screening. Randomized controlled trial in Poland, Norway, the Netherlands, and Sweden Average-risk population, population-based. 94,958 men and women aged 55 to 64 years. Colonoscopy screening or no-screening. This paper reports on screening participation, yield, and subject experience. Study outcomes were compared by country and endoscopist. Of 31,420 eligible subjects randomized to colonoscopy 12,574 (40%) attended screening. Participation rates were 60.7% in Norway, 39·8% in Sweden, 33% in Poland, and 22.9% in the Netherlands (p<0.001). The cecum intubation rate was 97.2%, with 9,726 (77.3%) of subjects not receiving sedation. We observed one perforation (0.01%), two post-polypectomy serosal burns and 18 bleedings due to polypectomy (0.15%). 62 subjects (0.5%) were diagnosed with colorectal cancer and 3,861 (30.7%) had adenomas, of which 1,304 (10.4%) high-risk adenomas. Detection rates were similar in the proximal and distal colon. Performance differed significantly between endoscopists; recommended benchmarks for caecal intubation (95%) and adenoma detection (25%) were not met by 6 (17.1%) and 10 endoscopists (28.6%), respectively. Moderate or severe abdominal pain after colonoscopy was reported by 16.6% examined with standard air insufflation versus 4.0% with carbon dioxide insufflation (p<0.001). Colonoscopy screening entails high detection rates in the proximal and distal colon. Participation rates and endoscopist performance screening vary significantly. Post-procedure abdominal pain is common with standard air insufflation and can be significantly reduced by using carbon dioxide. NCT 00883792.